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Butting heads over India’s tobacco
GUWAHATI, DEC 28 (AGENCIES):
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Published on 28 Dec. 2009 11:23 PM IST
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Tousle-haired teenager Sudip Singh admits he buckled under pressure. Last month, the 15-year-old began using gutkha, a cheap chewing tobacco that has taken India by storm over the past decade. Singh’s two older brothers and most of his friends have used gutkha for years in this blue-collar city in the northeastern state of Assam. A few weeks into his habit, still searching for a brand to call his favourite, Singh stands next to a roadside shop and studies dozens of glittering packages of gutkha with inviting labels that hang like sausage links. One package features the image of Disney character Minnie Mouse. “I enjoy it, what other reason do I need,” he says. It’s widely accepted that in Canada the battle against big tobacco has made strides in recent years. In 1965, roughly half of adult Canadians called themselves smokers. These days, just 17 per cent of Canadians call themselves smokers. But in India, the story is far more sobering. Some 1 million Indians will die this year from tobacco-related diseases, a figure that’s surged 43 per cent from 2005. An alarming 57 per cent of India’s 1.2 billion population use gutkha or smoke traditional cigarettes or the hand-rolled, unfiltered variety known as bidis. The problem is that there is a growing view within the ministry of health in New Delhi that some leaders have conspired to stop their efforts to curb tobacco use, watering down warning labels on tobacco products, stalling attempts to ban smoking from popular and influential Bollywood movies, and failing to ensure India’s anti-tobacco laws are enforced. “There’s this belief that the heavens will fall if you do something against the tobacco industry,” says Jagdish Kaur, the government’s chief medical officer. “It’s maddening. You have to ask, `What are we handing the future generations of this country?’” One of the most troubling aspects of tobacco use here, Kaur says, is how many pre-teens and teenagers consume tobacco. By the time they are 10, 37 per cent of children are smokers or chew gutkha. In the grassy courtyard of Arya Vidyapeeth College, a local high school in Guwahati, the grounds are littered with empty gutkha wrappers and dozens more float along a nearby open sewer. “We know it’s bad but everyone is doing it,” says Indrani Das, 18, who began chewing gutkha two years ago. Thanks to breakthroughs in India’s packaging industry, small, affordable packages of gutkha became widely available in the 1990s. Das says she buys packets for about 2 cents apiece at a shop just a few steps from her college – even though Indian law requires tobacco products to be sold no closer than 100 yards from any school. Walking through Guwahati, shops selling gutkha and other forms of tobacco seem to be spaced at 10 metre intervals and many are found on the doorsteps of primary schools. “How do you expect children to say no?” says Srabana Bhagabaty, a doctor at the B. Borooah Cancer Institute in Guwahati. “It’s cheap; it’s everywhere.” Many companies that make it also sell a product called pan masala, a concoction of candied breath fresheners. Both products are usually sold in similar packaging using identical logos, sometimes with the lure of a popular (unlicensed) cartoon character like Minnie Mouse. Dr. Prakash Gupta, an epidemiologist and tobacco researcher in Mumbai, says some grocers give gutkha to youngsters in lieu of change, while some companies hand it out for free outside schools. One health-industry paper in March 2008 quoted a doctor in the western state of Maharashtra who had treated a 4-year-old with oral submucous fibrosis, an untreatable tobacco-related ailment which saps the elasticity from the mouth. As was the case in Canada, Indian politicians for years have been uneasy about doing anything to upset the powerful tobacco lobby. Manikchand, one of the country’s top gutkha manufacturers, for years sponsored the Manikchand Filmfare Awards, India’s version of the Oscars, while cigarette companies often helped foot the cost of cricket match broadcasts. But in 2003, the Indian government passed a law banning tobacco advertising, a regulation that was surprisingly accepted by tobacco companies. The support, however, was a cunning smoke-and-mirrors tactic, says Prabhat Jha, a University of Toronto professor who is an expert on tobacco in India. Through the 1990s, U.S. tobacco giant Philip Morris gained a toehold in parts of Asia with its stable of brands led by Marlboro. India’s few tobacco companies worried Marlboro would break into the Indian market. So with the support of the Indian Tobacco Co. and others, India passed its anti-advertising law in 2004, throwing up a roadblock to Philip Morris. Meanwhile, India’s tobacco companies found other ways to build brand awareness. International Tobacco, whose Wills brand of cigarettes is one of the country’s most popular, opened a clothing chain called Wills Lifestyle, using a logo for its stores that was similar to its cigarettes. Rival Godfrey Phillips had sponsored the “Red and White Bravery Awards” since 1990, named after its cigarette brand of the same name. After the ad ban, the contest’s name was changed to the Godfrey Phillips National Bravery Awards. Three years after the ad ban, Kaur proposed the introduction of warning labels featuring the effects of tobacco use, such as oral cancer, on 50 per cent of packaging. A six-member panel was formed to consider the idea. Chaired by the current finance minister Pranab Mukherjee, the group included Civil Aviation Minister Praful Patel, who owns one of India’s largest bidi manufacturers. Mukherjee is a member of parliament from West Bengal, one of India’s largest tobacco-producing states. In a Jan. 21, 2009, letter to then-health minister Anbumani Ramadoss, R.A. Poddar from The Tobacco Institute of India asked the government to consider a “pragmatic” tobacco policy since the industry remains a “source of livelihood for 38 million people.” Poddar said warning labels would be ineffective since 70 per cent of cigarettes here are sold by the stick. On March 15, 2008, the prime minister’s office accepted from Mukherjee’s group an alternate set of warnings – without consulting the ministry of health. The ads, which debuted last May, were designed by the Ministry of Information and Broadcasting, which, coincidentally, remains in court battling Kaur’s department’s attempt to have smoking banned from movies. Instead of placement on both sides of packaging, the warnings cover 40 per cent of one side. And the warnings themselves were “watered down,” health ministry officials say. One showed the silhouette of a scorpion. Another featured a fuzzy x-ray scan of a set of lungs. Surveys commissioned by the ministry of health and reviewed by the Star show many respondents believe the lungs looked like “two old men bowing to one another” and said the scorpion was “cool.” Gupta asks: “How do those warning labels get passed into law without discussion in Parliament?” However, some tobacco companies have ignored the new regulations. A New Delhi-based activist group known as HRIDAY in a recent study surveyed 60 tobacco packages from nine Indian states. The majority of packages either didn’t display any warnings at all or the warnings didn’t conform to new government rules. Still, Kaur finds reason for optimism – the warning labels are there and she plans on pushing for more aggressive labels and a wholesale countrywide ban on gutkha. Neither Poddar nor Rajnikant Patel, president of the All India Bidi Industry Federation, returned calls for comment. In an Aug. 30, 2000, letter to the World Health Organization, Patel described bidi as the “only source of relaxation (and) luxurious indulgence for a poor burdened man.” The University of Toronto’s Jha accepts Patel’s argument to a point. “The argument is there shouldn’t be a nanny state and these poor folks have no other pleasures so why would western killjoys rob them of that with political objectives,” Jha says. “O.K., but to counter that, how much freedom does a poor person have, getting addicted, suffering a disease. And what about a smoking man’s wife who is left to hold things together if he dies?” In a ward in the B. Borooah Cancer Institute, teacher Habibur Rahman, 45, contemplates his future after a lifetime of chewing gutkha. “It cost practically nothing, maybe one rupee a day,” Rahman says. But last year, Rahman discovered he had oral cancer and needed surgery, an operation that cost him and his family 200,000 rupees ($4,500). “It’s clear now that there has been a cost,” Rahman says grimly.

 
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